Mental Health Nursing & Pharmacology

Foundations in Psychiatric Mental Health Nursing

• Risk factors increase the chance of mental illness development.
• Risk factors can be external like poor self-concept, dysfunctional relationships, lack of support, or social/cultural factors.
• Risk factors can be internal, like genetics, medical comorbidities, intrapartum complications, or traumatic brain injury.
• Protective factors and resilience are linked, with resilience defined as the ability to bounce back and overcome stressful barriers.
• Protective factors reduce the risk of mental illness and can be internal or external.
• Internal protective factors include a healthy lifestyle, high self-esteem, spirituality, motivation, and childhood attachments to caregivers.
• External protective factors can include safety, caregiver support, group/sport participation, and access to medical care.
• Maternal history of mental health issues prior to pregnancy increases their chance of complications during pregnancy by 40%.
• Mothers with mental health issues prior to pregnancy have a 50% chance of non-live birth; these mothers also have twice the risk of low birth weight.
• Physiological internal risk factors consist of neurotransmitter imbalance, genetics, and intrapartum complications.

Effects of Maternal Drug Use

• Cannabinoid use can cause attention deficits, future substance abuse and depression, poor growth, and long-term problems with executive function.
• Caffeine use can cause increased chance of prematurity and problems in executive function once in school.
• Psychostimulant use can cause preterm labor, behavioral problems, attention deficits, brain abnormalities, cardiac anomalies, aggression, and anxiety/depression.
• Alcohol use can cause decreased growth, attention deficits, prematurity or spontaneous abortion, cognitive delays, brain abnormalities, and problems with limb and facial development.
• Tobacco use can cause lower birth weight, ADHD, poor academic performance, aggression in adolescence, and oppositional defiance.
• Opiate use can cause neonatal abstinence syndrome, preterm birth, lower weight, heart defects, low IQ, behavioral problems, and respiratory problems.

Hildegard Peplau's Theory

• Hildegard Peplau is considered the mother of psychiatric nursing as well as developed the theory of interpersonal relations.
• Hildegard Peplau's theory focuses on the therapeutic use of self to promote well-being, helping nurses become self-aware and helping clients build autonomy in problem-solving.

Assessment Tools

• A registered nurse might use several assessment tools to assess a patient.
• A registered nurse might use a mental status exam and psychosocial assessment as assessment tools.
• A registered nurse might review patient's psych meds and screen for SI, trauma/violence, substance misuse.
• A registered nurse might use spiritual assessment to asses coping skills; they also examine lifespan development/cultural considerations and labs.

Types of Stigma

• There are four types of stigma that can be recognized.
• Self stigma involves internalizing negative stereotypes related to mental illness.
• Public stigma involves endorsing stereotypes about others with mental illness.
• Institutional stigma involves maintaining policies that decrease access to services for people with mental illness.
• Affiliated stigma is being affected by stigma directed at another person with mental illness.
• Stigma motivates the public to fear, reject, avoid, and discriminate.
• Affiliated or internalized stigma relates to caretakers of people dealing with mental illness.
• A mental health issue can result in discrimination.
• Implicit bias is prejudice beyond consciousness or control
• Explicit bias is attitude people are aware of.

Prejudice vs. Discrimination

• Prejudice is biased thinking.
• Discrimination is ACTION against groups based on factors like race, ethnicity, age, religion, gender, or disability.

Nurse-Client Relationship

• The foundation of client-centered care is NOT therapeutic communication.
• A strong nurse-client rapport is built through acting professionally, asking questions, listening to answers, and setting the tone.
• During active listening, the nurse aims to capture the message's meaning, intention, and content.
• Actively listening consists of facing the patient, having eye contact, focusing on verbal/non-verbal cues, and being nonjudgmental.
• Self-awareness is important in the nurse-client relationship.
• Known to self and others is the arena.
• Known to others but not to self is the blind spot.
• Known to self but not others is the facade.

Communication

• Undergird communication elements include honesty, ethics, and legal considerations.
• Let the patient know shared information will be told to the treatment team, particularly with SI or HI.
• Transference versus countertransference is important to recognize in a patient encounter.
• Transference is when the patient reacts triggered by past relationships.
• Countertransference is when the nurse has triggers toward the client that can influence their attitude toward the current patient.
• It's important to know the difference between objective and subjective patient data.
• It's important to recognize non-verbal communication and cultural sensitivity.
• The lack of non-verbal communication is a barrier.

Barriers to Therapeutic Communication

• Barriers to therapeutic communication consist of inattentive listening, using medical terminology, and asking personal questions unrelated to the visit.
• Expressing approval or disapproval, changing the subject, making minimizing remarks, providing false assurance, expecting justification, and disagreeing with the client are barriers.
• Mutual trust and respect are the foundation of the therapeutic nurse-client relationship.
• A therapeutic relationship nurtures health, hope, wellness, empathy, and therapeutic interventions.

Four Phases of the Nurse-Client Relationship

• The first phase pre-orientation and tasks
  • The nurse reflects on the feelings the client and their situation
  • The nurse analyzes their own weakness in the context of the patient
  • The nurse collect info about the pt and prepare plan of care
  • Collect can occur after bedside report or rounds -> strong element on collaboration with nurse, social worker, mentor, doctor etc
• The second phase is orientation and its tasks.
  • Establish rapport with client and create an environment that feels safe
  • Initiate communication for why they are seeking treatment
  • Identify problem areas and plan protentional interventions
• The third phase is working and its tasks.
  • Therapeutic interventions to encourage self-reflect
  • Collaboration with the pt to identify stressors and insight on problems.
  • Collection of data continues
  • Encourage independently and redefine the problem as needed.
• The fourth phase is termination and its tasks.
  • Critical phase is discussed orientation phase
  • Is to have pt fix their issues with independence and confidence
  • Explore nurse-patient and patients feelings

Physical Boundaries

• Know the importance of physical boundaries in a therapeutic relationship
• "Proxemic" refers to how much physical distance pt. like to have when conversing
  • Zone is intimate space from physical contact to eighteen inches
  • Personal space one to four feet in distance, more agreement if it closer
  • Social space distance is four to twelve feet, as relationship, no closer four feet
  • Public space distance is greater than twelve feet

Emotional Boundaries

• Discuss to emotional boundaries in a therapeutic relationship
• Maintain respect for patient, avoid in judging
• If the patient is depressed they may not answer all question in one sitting.
• Avoid in sharing intimate details their life.
• Avoid in take work or lunch breaks
• You can do small talk ease patient into interview

Therapeutic Vs. Social Relationships

• Therapeutic relationships differ from social relationships.
• Therapeutic are directed toward clients needs per assessment, but not cross personal information
• Social relationships meets needs on both sides, each shares feelings and experiences with the other
• Therapeutic Follows steps of nursing, and show empathy, setting the tone "I'll be here until 3:00"
• Social Relationships Does involve planning or evaluation, more sympathy, NO time stages
• Therapeutic is pre-orientation, working, and termination Never sexual, no expectation for client to meet
• It important to client beliefs , human perceptions, culture, spirituality, language

Physical vs. Psychiatric-Mental Health Nursing Assessment

• There are differences between a physical and psychiatric-mental health (PMH) physical nursing assessment.
• Physical: vitals, wt/ht, imaging, neuro assessment
• Identify characteristics of a psychosocial assessment.
• Psychosocial: evaluation of pt's mental health in relation to their social wellbeing
  • Home environment, Education/employment, Hobbies, Drug/tobacco/alcohol use, Sexuality/gender
• Be familiar tools of assess pt. Mini-Mental Status Exam, BPRS

Milieu Management

• Role of the nurse in milieu management
• Primary is discharge planning
• Define least restrictive and recognize examples.
• Goal is to choose the least restrictive environment with the most effective treatment that Places
• with the primary goal of inpatient hospitalization.
• Pt with acute psychiatric symptoms who can't remain in outpatient or home. Can be either voluntary/ involuntary based on the state
• If they sign in voluntary can be frustrating to pt.
• Goal of partial hospitalization program
• "Step down" Need of high level of care
• The pt advantage can go home end the day

AA meeting

• Is example of what type of group
• Peer Support group
• What is a certified peer specialist
• A person who is usually nonclinical who help develops goals
• How would the nurse promote group cohesiveness?
• Nurse can read a list of expectations prior to start
• The nurse will make sure everyone gets time speak

Prochaska's Stages of Change

• Understand the cyclical pattern of substance treatment, recovery
• It can become barrier or either discouraging
• Be aware of potential barriers affecting patient use
• If they are can't use internet of new technologies
• This affects more patient use
• The patient is more safe /familiar in other environment
• If they act psychotic, suicidal or impaired pt. are the NO candidates
• Is a lack intern access, chaotic enviorment

Serious Drug Reactions

• Know the signs & symptoms , management, associated with meds)
• Neuroleptic malignant syndrome
• Rare, a progression can be RAPID over few hours to death S/S: severe muscle rigidity, unstable VS with high fever, delirium
• treatment: admission, stop agent, bromocriptine, iv fluids, cooling,muscle relaxants

Serotonin and Hypertensive Crisis

• Serotonin syndrome
  • caused by excessive serotonin
  • s/s:unstable/elevated VS, restlessness,agitation,seizure,death
  • Treatment: icu stop med,cyproheptadine or IV
• hypertensive crisis
  • s/s: severe headache,sob,chest pain, Confusion
  • Tx: icu admit , stop offend, like nms with blanket
• Stevens-Johnson Syndrome and lithium toxicity
  • Steven cell mediate
  • risk Lamotrigine
  • Lith narrow therap

EPS Symptoms

• EPS symptoms are high risk
• First generation antipsychotics Akathisia: they complaints with
• rocking, pacing, restless
• The muscle hurts, starts in the head
• Tardive dyskinesia in affect the tongue, blinking, months to year permanent.
• First step is reduce dose
• Clonaze
• action is SRI's .maois an

Agranulocytosis

• Clozapine with neutrophils
• Action Is and reuptake
• Cause Serotoin and hyper
• Meds for bipolar
• Lithum or SJS

Questions covering contraindications and side effects of depression treatments like TMS, ECT, esketamine, clozapine, SSRIs, and MAOIs. Also includes questions on nurse-client relationships and therapeutic communication.